The Ethics of Behavioral Health Information Technology

Michelle Joy, Timothy Clement, and Dominic Sisti. "The Ethics of Behavioral Health Information Technology: Frequent Flyer Icons and Implicit Bias." JAMA, September 8, 2016.

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A subpopulation of individuals with serious mental health conditions makes repeated and frequent visits to emergency departments and psychiatric crisis centers. These so-called super utilizers often have financial problems and present with chronic or untreated comorbid psychiatric and substance use disorders. These patients are often well known to clinical staff and are sometimes colloquially labeled “frequent flyers.” A pejorative branding, “frequent flyers” are often assumed to be problem patients.

These patients can be identified in different ways.... One electronic medical record system provides an airplane icon, which system administrators may elect to configure so that clinicians can identify a patient as a high utilizer.

This iconography is ethically and clinically inappropriate for 2 interdependent reasons.